How to provide affordable medical imaging and diagnostics through health plans eba

Most cost-effectiveness assessments for screening and diagnostic tests are based on imaging costs in university health systems, not the affordable test pricing that can now be provided fairly widely in employer-funded. health plans,

The widespread availability of more affordable quality screening and diagnostic tests nationally — combined with lifestyle and health changes brought on by the pandemic, and COVID-19’s disruption to cancer screening and diagnostic imaging — has likely changed that equation. Clearly rigorous studies need to be done to re-evaluate the cost-effectiveness.

But “cost-effectiveness” also has a different equation in the employer-health plan space because time lost from work and work efficiency are also affected by employee health status. four weeks late cancer treatment linked to a 6% to 13% higher risk of death, according to a 2020 study published In british journal of medicine, This upstaging allows for more invasive and costly therapy and lost time from the workplace.

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According to a review article published in January 2022 by Texas Tech University, colorectal cancer is the second leading cause of death in the U.S. By April 2021, routine screening colonoscopy rates were 50% lower than pre-pandemic, resulting in a 53% decline. Was. Surgery related to colorectal cancer. Total US shortfall in colorectal cancer screening estimated at 3.8 million

With a backlog of three to four months at endoscopy centres, alternative screening methods such as fecal immunochemical Testing and DNA stool technology should be considered for individuals at moderate risk, even though it will not prevent colonoscopy if the result is positive. The economics of covering DNA testing for these individuals to catch the disease at an early stage, even if the interval for re-screening is shorter than colonoscopy, needs to be re-evaluated.

Screening mammography is covered by most employer health plans, but a woman with a new lump in her breast is usually subject to a deductible and co-insurance for diagnostic mammography and ultrasound. Mergers and acquisitions in the radiology and outpatient imaging space are dramatically driving up the cost of these exams. This means that it is not uncommon for out-of-pocket expenses for these studies to exceed $1,000 at contracted rates in employer self-funded health plans, well above the price. $400 Half of Americans Don’t Have To spend on health care emergencies. These numbers strongly suggest that employers should consider covering all breast imaging free of charge in their plan design.

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Nonalcoholic fatty liver disease is a silent epidemic in the US affecting up to 20% of adults and 10% of children. It is an established risk factor for the leading causes of death and disabilityCancer, heart disease and type 2 diabetes. Screening for liver fat can be done in an inexpensive setting with a portable machine (at the workplace or near-site clinic) with an abdominal ultrasound. In addition, lifestyle changes can reverse the disease and prevent long-term illness and costs.

The same ultrasound examination can detect tumors in the abdominal organs, fat deposits in the kidneys as precursors of diabetic kidney disease, and atherosclerotic aortic disease or aneurysms. And the most sensitive test for measuring cardiovascular risk isn’t a stress test. This calcium score is computed tomography (CT). The same portable ultrasound machine can be used to measure the thickness of a layer of a blood vessel in the neck to screen people who should have a CT exam to quantify their risk. Both the carotid and calcium score CT scans can be quite affordable for self-funded health plans if members are steered to reasonably affordable providers.

The economics of health care when self-financing employers perform their fiduciary duty and contract for services through affordable independent providers rather than subjecting plans and members to skyrocketing contracted rates in hospital systems and private equity-backed consolidators turns. Dollars that would have been better spent could instead be redirected to early indicators or detection of disease and early cancer, and diverted to raising wages or improving other benefits.

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